Endocrine (27) Flashcards
fluorescein angiography diagnoses ____ (sx: bleeding that causes sensation of falling curtain obstructing visual fields or eye floaters)?
diabetic retinopathy (**asx early in dz —> falling curtain sensation meaning vitreous bleed —> floaters that represent resolution of the bleed)
Lens refraction tests?
myopia (near sightedness), hyperoptia (far sightedness), astigmatism (irregular curvature of lens)
fluorescein staining dx what three things?
corneal abrasions, ulcers, infection (HSV, CMV)
how does fluorescein angiography work?
elucidate microaneurysm formation and neovascularization.
Subacute thyroiditis:
Phase 1: ____ wks of painful thyromegaly and hyperthyroidism. (inflammation induced release of thyroxine —> incr TSH)
Phase 2: ____wks asx, euthyroid
Phase 3: _____ time of hypothyroid (burnout of thyroid gland)
1 - 3-6wks
2 - 1-3 wks
3 - wks to mo
thyroid peroxidase antibody found in___ (a hypothyroid)
hashimoto thyroiditis
thyroid stimulating immunoglobulin is found in ____ (hyperthyroid)
grave’s disease
First step in tx of pt with pH 7.26, antion gap metabolic acidosis, elevated serum beta-hydroxybutyrate and urine ketones
this is alcoholic ketoacidosis:
- tx with thiamine
- NS and dextrose
how do you dx anaplastic thyroid carcinoma?
open surgical biopsy
mets of anaplastic thyroid carcinoma
LBB - lungs, bone, brain
MOA of metformin
- decreases hepatic gluconeogenesis
2. increases insulin sensitivity in peripheral tissues
CI to metformin:
Cr >____ in M or ____ in F.
- 5mg/L
1. 4mg/L
insulin, loops, reisns, alkalinizing agents, and Beta agonists (i.e. inhaled or systemic) are good for what ion abnormality?
good for reducing potassium, may cause hypokalemia.
Name the four ways of DM dx?
- fasting bs > or = to 126 on two occasions
- HbA1c > or = to 6.5% on two occasions
- 2 hr post oral GTT of bs > or = 200
- a random bs > or = 200 in a pt that already has sx
self limiting, rapid growing painless mass w/ or w/o sx of obstruction in neck. ey/hypo/hyerthyroid.
dx procedure?
dx?
open surgical biopsy to dx Reidel thyroiditis.
distinguish it from malignant anaplastic thyroid carcinoma
function of PTH
keep enough Ca in blood - release from bone
parathyroid, pancreatic, pituitary adenoma =
MEN1
mucosal neuromas, marfanoid, pheochromo, medullary thyroid ca = ?
MEN 2b
parathyroid hyperplasia, pheo, medullary thyroid Carcinoma
MEN 2a
What does this outcome of HD-dexamethasone test mean?
ACTH undetectable and cortisol not suppressed
Primary hypercortisolism (tissue producing cortisol w/o regulation or ACTH stimulation)
Dx: HD-dex suppression test
What does this outcome of HD-dexamethasone test mean?
ACTH elevated and cortosol not suppresed
ectopic ACTH production (Cushing’s syndrome) –> paraneoplastic syndrome producing ACTH
Dx: Chest CT and abd CT
two cancers that cause paraneoplastic syndrome producing ACTH.
adrenocortical carcinoma
small cell lung carcinoma
What does this outcome of HD-dexamethasone test mean?
high-normal ACTH and suppressed cortisol
ACTH pit adenoma (B9 tissue producing too much ACTH) –> cushing disease
(Dx: pit MRI)
first step in dx euthyroid pt (normal TSH) with thyroid nodule
FNA to distinguish b/w B9 and malignant thyroid tumors
if thyroid nodule is found and TSH is low, what are the three findings of a radioactive iodine?
hot - increased activity (B9)
warm - same uptake as surrounding tissues –> FNA next
cold - decreased uptake –> FNA next
First line medication for prevention of progression in a person with a T score of below -2.5 (or @risk -1.5 to -2.4)
osteoporosis DoC tx bisphosphonate (ibanDRONATE) for TX and PREVENTION
or
denosuMAB
vitamin D, Ca, vit A, thiazide diuretics, lithium can all cause….(stones, bones, abd groans, psychic overtones)
hyperCa and hyperPTH
stones - nephrolithiasis
bones - osteoporosis
abd - cramps, N/V/constipation
psychic - anxiety, depressed
in what population are HbA1c readings inaccurate?
CKD!
HA, Sickle Cel, EPO therapy
how can diabetic gomerulopnephropathy be prevented - add ___ class?
(all DM should be on this)
add ACE inhibitor (-prils) –> inhibits constriction of efferent renal arteriole
edema, hypoalbuminemia, proteinuria >3g/d
diabetic Glomerulonephropathy with nephrotic syndrome
most sensitive test for hypothyroid
1) serum TSH –> then do 2) T4
94% specificity means…
94% of people w/o the disease test negative - it correctly assesses disease free pts 94% of the tie
Tx of choice for hyperparathyroidism with osteoporosis
Parathyroid gland removal
pre diabetes HbA1c range
5.7-6.4%
hyperthyroid sx controlled with:
beta-blockers (i.e. -olol)
PTU adn methimazole are antithyroid, but take 2-8wks to reduce excess thyroid hormone production
